Provider Demographics
NPI:1891019691
Name:SANTOS, DANIELLE RENEE (ASW)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:RENEE
Last Name:SANTOS
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 CHANATE RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-1707
Mailing Address - Country:US
Mailing Address - Phone:707-565-4900
Mailing Address - Fax:707-565-4814
Practice Address - Street 1:3333 CHANATE RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-1707
Practice Address - Country:US
Practice Address - Phone:707-565-4900
Practice Address - Fax:707-565-4814
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2021-12-01
Deactivation Date:2021-03-04
Deactivation Code:
Reactivation Date:2021-04-28
Provider Licenses
StateLicense IDTaxonomies
CA615961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical